Aerophagia SUCKS!!

Hello all, thanks for taking the time to read this!

I am a new CPAP user, using the Resmed Elite S9 CPAP with humidifer machine, pressure at 9.0. I like to think I can adjust to pretty much anything in very little time, and for the most part, this has been the case regarding CPAP therapy. I can easily fall asleep with the mask on my face, and the nasal pillow mask seems to be best one for me.

The first two nights were almost perfect. I even checked my stats with SleepyHead, and saw that my AHI for the first two nights were 0.00 (yep!) and 0.61 respectively. But the following nights, I averaged in the mid 2's, with my hourly chart showing me hitting as much as 7 events during some hours...

But worst of all is the swallowing of air. Last night was absolutely horrible, because the feeling of air being pushed into my guts down my throat woke me up at least twice. The gurgling sound and disgusting feeling was awful, and I've been feeling lousy and somewhat nauseous all day.

I've tried, changing my sleep position earlier, including tucking and not tucking my chin, sleeping on my back, or not using any pillow. In the end, none of these were comfortable enough to sustain throughout the night.

I've already called my doc, and am expecting to hear back from her, but I'm just looking for any anecdotal solutions any of you might have. I definitely don't want to go through this again tonight.

Also, can someone explain how GERD affects aerophagia? I may have it, but am not piecing together how the two relate to one another.

Thanks!

I know the feeling. I tooted up a storm this morning in bed, after my first night on my machine.

JV1967 wrote:I know the feeling. I tooted up a storm this morning in bed, after my first night on my machine.

Since you are a musician I can understand the tooting.......

GERD can damage the lower esophagus where it enters the stomach. This area has something called LES (Lower Esophageal Sphincter) when it is damage can lose some of its strength and thus it doesn't do as good of a job staying closed tight enough to help keep the air that is in the esophagus from entering the stomach.

You are using 9 cm pressure...are you using EPR? If so, at what setting?
If not using EPR then for sure try using EPR as it is the first thing we suggest someone try to help reduce the GI distress from aerophagia.
If you are using EPR at a lower setting...then try higher setting.
If you are already using EPR at the max of 3...we probably need to discuss other options.

LSAT wrote:

JV1967 wrote:I know the feeling. I tooted up a storm this morning in bed, after my first night on my machine.

Since you are a musician I can understand the tooting.......

I called my doctor, because my max pressure last night was over 18, and though I had a really low AHI, I need this air swallowing stuff resolved, too.

I have a wedge pillow. I might try it out for this. By the way, does sleeping on your back, raised up, cause more apneas?

Sorry to hear that you're dealing with the aerophagia.

You write:

bborisbb wrote: Also, can someone explain how GERD affects aerophagia? I may have it, but am not piecing together how the two relate to one another.

Short answer: Folks with GERD often have weak lower esophageal sphincters (LES), and when your LES is weak, it's prone to leaking. That's what allows the acid to reflux in GERD, but that leaking also allows air from the CPAP to enter the stomach, which is what leads to aerophagia.

There's also some evidence that OSA can lead to problems with GERD. This is one that I don't fully understand, but it has something to do with negative pressures in the airway that occur when the upper airway is collapsed, but you're trying (hard) to breathe---i.e. the diaphragm is still moving up and down trying to move air into and out of the lungs. But because of the collapsed airway, the negative pressure in the lungs, which would ordinarily allow air to move into them, doesn't result in air coming down the airway. And the negative pressure in the (lower) airway can then pull stuff up from the stomach through the LES, which can lead to GERD.


Long answer: Recently Morbius quoted a post he'd made several years ago (under the name deltadave) about the connection between aerophagia, arousals (even NON-respiratory related arousals), and GERD. In response to a question about what causes aerophagia, he wrote:

Morbius wrote:And don't forget "Bad Sleep:

deltadave wrote:

robysue wrote:Are you saying:

Arousals lead to aerophagia and aerophagia leads to decreased sleep efficiency due to additional wakes caused by the aerophagia?

'Zactly!

CarpeNoctum wrote:Gerd/aerophagia causes arousals more the awakenings.

The algorithm below attempts to explain the relationship of all these factors, but did you review the other posts in that thread?

deltadave wrote:

ignorant1 wrote:That begs the question of if that would cause a change in thoracic pressure, enough to overcome the LES “seal” against the increased respiratory tract pressure from xPAP?

The pressure required to open a normally functioning closed LES is about 25 - 33 cmH2O. Clearly, the unpredictability of aerophagia requires there to be other factors underfoot.

Keep in mind that the easiest way to relax an LES is to simply swallow. (As an aside, I would also offer that the easiest way to elicit a swallow during sleep is to generate an arousal, which may be the mechanism of the PLM point. It's not PLMs, it's the subsequent arousals).

In re: inspiratory waveform engineering, if you rapidly force a breath into a dead (essentially) cat, you can elicit some potentially untoward responses:

In 2001, Lang and colleagues found that esophageal receptors trigger relaxation of the UES on sensing rapid distension, but activate contraction of the upper esophagus (including contraction of the UES) on sensing slow distension.

Easy To Understand Regina Patrick Article

Complicated Scientific Stuff

It would seem then, that this phenomenon would preload the esophagus and create the milieu for aerophagia (in order to have aerophagia, you need some "phagia".

deltadave wrote:Interesting stuff to read (and previously referenced by -SWS in a short, largely unnoticed thread):

CPAP and Things That Go “Burp” in the Night

Aerophagia and Gastroesophageal Reflux Disease in Patients using Continuous Positive Airway Pressure: A Preliminary Observation

deltadave wrote:Arousals.

It's always about sleep quality.

JV1967 wrote:I called my doctor, because my max pressure last night was over 18, and though I had a really low AHI, I need this air swallowing stuff resolved, too.

In your case you need that higher pressure to deal with your centrals...it has to be fast and high to do what you need done.
So sorry to have to tell you that but you can try the wedge pillow thing to see if it helps...upright helps the air go up (burp) and maybe not get into the lower digestive system so much.

Usually side sleeping is the best option to help prevent the air in the gut. I think it is left side down (but can't swear to it) to let gravity and weight help compress that LES junction and keep it closed better.
But you can sure try all positions to see if one position helps or not and if it is better on your back...then sleep on your back if that lets you sleep well without adding too much GI distress.

I was tested for GERD by having a barium swallow x ray session at the hospital. Results were that I don't have it.

I have a problem in that I can only sleep on my left side, due to a head injury, so if I sleep on my back with raised pillows, will that cause more Aerophagia? Last night I slept both on my side, and on my stomach, with my head raised higher than my body, and I had some pretty rough strap marks on my face this morning.